Provider Demographics
NPI:1033528542
Name:MAERTEN, MICHAEL
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MAERTEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:MAERTEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSED, CCC-SLP
Mailing Address - Street 1:7 BURLINGTON ST
Mailing Address - Street 2:APT. 1
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-4007
Mailing Address - Country:US
Mailing Address - Phone:716-480-7887
Mailing Address - Fax:
Practice Address - Street 1:7 BURLINGTON ST
Practice Address - Street 2:APT.1
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-4007
Practice Address - Country:US
Practice Address - Phone:716-480-7887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MASP-9322-SL235Z00000X
FLSA 12531235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist